In looking at countless quack web sites and having discussions with various quacks on message boards, the inevitable question that I ask myself is “What sort of quack am I dealing with – deluded or fraudulent?” The fraudulent quack knows they are promoting cures and remedies that do not work (above the placebo) but make money out of it anyway. The deluded quack believes they are promoting something genuinely wonderful, but misunderstood by ‘science’.

The more I delve into quackery, the more I believe that we are mostly dealing with the deluded. Frauds can be dealt with by legislation and prosecution. The deluded appear to be a tougher nut to crack – minds have to be changed. However, the belief systems around alternative medicine appear to be impervious to criticism and rational enquiry. The defensive walls are high.

This situation appears to be very similar to arguments surrounding religious beliefs. Religion is largely immune to rational enquiry with people who hold such beliefs as they have many defenses against such enquiry.

Richard Dawkins coined the term ‘meme’ to represent a ‘replicator of cultural information that one mind transmits (verbally or by demonstration) to another mind’. The God meme is usually at the foundation of religious beliefs. If you are unfamiliar with the concept of the meme then best start here. The point I want to make is that memes rarely appear on their own, but usually cluster together to form cooperating meme-plexes that help each other to survive. A God meme on its own may not last in a culture for long. Gods are notorious in their reluctance to offer direct evidence of their existence and so a God meme may soon be subject to attack from a sceptical mind. However, if you couple a God meme with a ‘faith is good’ meme and a ‘doubt is bad’ meme then together, these memes may form a more stable meme-plex. Any sceptic can be brushed aside as a ‘doubter’ and any self-doubt can be parried with a renewed sense of the need for faith.

I would suggest that Alternative Medicine advocates must surely also carry around similar meme-plexes of symbiotic ideas that prevent logic, reason, intelligence, science and experimental evidence from demolishing the core ideas of the practice.

However, a customer of alternative medicine need not carry around huge meme-plexes in order to take their medicine. A person need only believe a few things about homeopathy in order to try it – gentler than ‘western’ medicine, ancient principles, no side-effects, and so on.

However, the meme theory would predict that the stronger the advocate of homeopathy, the more memes need to be believed to fend off scepticism and evidence. This contrasts with a scientist; the closer you are to the science, the more facts and theory you will know – there is no need to hold beliefs that prevent rational enquiry about the science – their defense is the strength of the evidence. The homeopathists on the other hand needs more and more defensive walls around a small core of unchanging beliefs. So here is my hypothesis of the memetics of quackery and pseudoscience:

The greater advocate a person is for quackery, the more that defensive memes need to be held that can stall rational enquiry, whilst the core memes regarding the theory of the quack subject remain fairly constant with the degree of advocacy.

So we need to test this now. Maybe I can even build tests into the quackometer to spot pseudoscience and quackery!

Looking at the homeopathist example a bit further. The BBC’s Newsnight programme this week carried a report into how high street homeopathists are giving dangerous advice regarding the prevention of malaria. Of ten surveyed, all offered a homeopathic sugar pill to act as prophylactic and gave no other advice about bite prevention and the need to see your GP. This is appallingly dangerous as malaria kills. Melanie Oxley of the Society of Homeopaths appeared on the programme to answer these allegations. Her response was breath-taking in her inability to grasp the nature of what the accusations were and was a classic example of complete internal denial. Is Ms Oxley stuffed full of quack memes to prevent critical analysis?

The Society of Homeopaths has a list of press releases, the most recent one about the above BBC report. These press releases appear to contain lots of ‘official’ responses to complaints or criticism and so, according to my hypothesis above, be rich with memes for preventing rational enquiry into homeopathy.

Let’s dig out some of those memes…

1. In the response to the BBC report, the society is adamant still that homeopathy can act as an alternative to malarial prophylactics. (An utter outrage.) The society states the truth at one point:

At present, there is no large scale research evidence to support the use of homeopathy in preventing malaria.

but then goes to on to offer a list of memes to get out of this…

Consequently, there is substantial anecdotal evidence from around the world to suggest that homeopathy may offer a gentle, yet effective, complementary or alternative approach.…Clearly, this needs more research. Nevertheless, absence of evidence is not the same as evidence of inefficacy”.

So, we see several memes to ward of the uncomfortable nature of the truth – anecdotal evidence says is works and the (brilliant) “absence of evidence is not the same as evidence of inefficacy”. We would love to point out to them that anecdotal evidence is not sufficient to prove efficacy and of course, that absence of evidence is not evidence of efficacy.

2. The next press release is about Professor Michael Baum’s report that homeopathy is an implausible treatment for which over a dozen systematic reviews have failed to produce convincing evidence of effectiveness. The press release quotes a number of flawed studies to suggest that Prof. Baum is wrong, but also comes up with the exceptional defensive meme that

Access to [homeopathy] should be a matter of choice for individuals and TheSociety of Homeopaths firmly supports the Government’s agenda of patient choice.

In other words, freedom of choice is more important than evidence of efficacy.

3. The next defensive press release concerns an article in the Guardian, by our friend Ben Goldacre, regarding recent meta-analysis of trials showing homeopathy as being just placebo. The Society naturally brush this off and use another well crafted meme to dismiss this criticism:

It has been established beyond doubt and accepted by many researchers, that the placebo-controlled randomised trial (RCT) is not a fitting research tool with which to test homeopathy.

So, the cornerstone of modern evidence-based medicine cannot be used to test homeopathy – a very useful quack meme. Homeopaths complain that the ‘individualised treatments’ involved in ‘real’ homeopathy cannot be subject to placebo controlled trials. An obvious canard. Even more bizarrely, the claim here is that what is important is not what is in the pills, but the very experience of the consultation and dispensing of the pills. I would appreciate their sincerity in this belief, but I do not see the Society condemning Boots for offering off-the-shelf homeopathic pills.

I am sure there are more in there, but this blog entry has gone on long enough.

What does this mean for our fight against quackery? If it is true that most participants in quackery (both practitioners and customers) are more likely to be deluded and protected by defensive memes, rather than outright frauds, then legislation and prosecution may not do so much good. Rather we need ways to prevent these sort of memes and canards from being implanted in the first place. Better science education and science reporting in the press would go a very long way here.

11 Comments on The Memetics of Quackery – Part 1

A lot of good points there, particularly re the ‘fraudulent quacks’ who, as you rightly say, can “be dealt with legislation and prosecution”, or at least in the instances when action IS taken. But not particularly effectively.

I wonder if you have any thoughts about why prosecution consistently proves to fail in effectively dealing with fraud and scientific misconduct, in the pharmaceutical industry at any rate.

If a company promotes a drug or an alternative treatment and suppresses side effects observed in their clinical trials, (taking as a rather outstanding example, drug-induced suicidality or homicidality as in data suppressed by Pfizer, Lilly and GSK on certain blockbuster drugs) and as a result those drugs, or homeopathic remedies should that occur, cause the deaths of members of the public, would it be more realistic to seek prosecution of responsible indviduals with perhaps prison sentences as would be imposed on ordinary members of society?

Or should we continue on a course that has clearly failed to date by imposing relatively ‘soft’ monetary penalties on the company as a whole which, generally, is paid by the shareholders and fails to make any temporary or lasting impression on corporations or individuals within it who commit the criminal acts?

What would you suggest as a solution to halting quackery in orthodox and alternative medicine?

“Better science education and science reporting in the press would go a very long way here.”

Up to a point, but in the case of orthodox medicine in particular there seems to be a clear stumbling block in the way.

Unfortunately, when leading academics who have received the best of science education but then choose to disgard both ethics and science by, for example, authoring publications which are then promoted, often very successfully, under the banner of science but which are inaccurate and intended to misinform the majority of phsycians, the public, the regulators etc, it is difficult to conceive how further science education will help, or how the press can possibly become better informed.

You are clearly quite far up your own arse, perhaps too far to read to the following, but here goes anyway…

We know that bioactive chemicals can be used medicinally because of the experimental methods developed by medical science. These methods have been specifically developed to test the effects of single bioactive chemicals on our bodies. Yet, it is one thing to say ‘we have an experimental method that enables us to develop medicines from single bioactive chemicals’, but it is another matter entirely to say, as medical scientists do, ‘therefore, all medicines must be developed using our experimental methods’. This is simply false logic. But it is the first article of dogma in the creed of the Church of Orthodox Medicine.

Yours is a proselytising religion – that is your burden. I see you and Mrs Duck pounding the pavements, knocking on doors and handing out copies of the Big Pharma Watchtower. I appreciate your concern for the state of my soul and the souls of my fellow non-believers. I know you’d like us to join you in pharmaceutical heaven. If only it weren’t for those pesky memes and meme-plexes.

Thanks for putting us on the couch and trying to analyse us, but I don’t think a meme-complex would stand up to an assault from Occam’s razor. I give it at least 10 canards.

Your zealotry (or is it OCD?) is becoming a tad boring. Try getting out more often or some day soon Mrs Duck will run off with Mr Drake…

That’s not an argument, that’s just an insult. Le Canard Noir failed to mention one of the favourite defensive tactics of CAM advocates: the ad-hominem attack, evidently your first option in this case.

The mathematics of statistics are abstract objects which can be shown to be absolutely true, within their abstract framework. If you can use this framework to develop an entirely robust methodology for maximising the probability that a homeopathic medicine is effective then this methodology will be absolutely acceptable as a means of testing medical interventions. As it stands, homeopathy has signally failed to propose such a mechanism, and appears to hide behind the argument, “We don’t believe that the RCT method is appropriate to our medicines, therefore we don’t need to test them in a meaningful way”.

I think you might be well served to spend less time attacking Le Canard Noir, and more time rigorously determining the basis for the treatments you support.

Don’t get too steamed up about the ad-hominem bits of my post – they were made in jest and I’m sure they’re water off the Duck’s back.

There was an argument in there, but perhaps your sense of humour failure caused you to miss it: article one of the Church of Orthodox Medicine?

Furthermore, us paid-up members of the Church of Alt Medicine are very happy with the knowledge accumulated over thousands of years of plant use (what we call empirical evidence of efficacy).

You may believe that experimental trials are the pinnacle of scientific achievement, but it is interesting to observe how the medical establishment chooses and loses its medicines. Firstly, radomised, double-blind, placebo-controlled trials ‘sex-up’ the evidence for the efficacy of a new bioactive chemical. Next, the chemical is approved as a prescription drug. Finally, evidence continues to be gathered about the drug’s harm-benefit through long-term studies, sometimes over decades. We would argue that this end stage is based on the evidence of experience (empirical evidence) and it makes, but more often breaks a drug…

Own up to it: without empirical evidence Orthodox Medicine would just be an elaborate way of killing more people than it already does.

You may think we lack scientific fibre, but clearly we pray to different gods.

Pluck the duck – your scientific ignorance betrays you. Do you understand what a straw-man is? Because that is what you are arguing with. Scientific medicine is not about ‘single bioactive chemicals’. Nonsense. What about radiatherapy, vaccination, physical therapy, surgury, dietetics, transplants and so on. Scientific medicine is about plausibility and evidence.

The funny thing is, now that your error has been pointed out, I bet you will still go on repeating the same old tired arguments.

If you want to debate on this site then stick to debate. Stupidy and abuse will be deleted – for your own good.

The daft thing is that you are still constructing a straw-man. You are arguing with yourself. So, instead of saying scientific medicine is just one idea, you now say it is many (x,y,z). Where do you think these ‘methods’ come from? They have been agregated over the last century or so as each diagnistic or therapeutic technique has proven safe and effective. Ideas have come from physics, chemistry, botany (yes, drugs from plants), biochemistry, genetics, pshychology and even sociolgy. Scientific medicine is always open to new ideas from wherever thay may come.

Compare and contrast with homeopathy – unchanged in two hundred years. No new ideas, no new insights, no integration with new discoveries.

Can you name one advance in homeopathy that has moved it on as new science has been discovered? And is agreed upon by most homeopaths? So, who is open to new ideas then?

My argument is a response to your patronising article, which suggested that practitioners of non-orthodox therapies (and their patients) hold an irrational, religious-like belief in the efficacy of their particular therapy.

That may be so. However, as I have repeatedly pointed out, many medical scientists (yourself included) hold a similar irrational belief that the orthodox medical model is self-evidently the only true model for medicine. In other words, nothing can call itself a ‘medicine’ unless it is developed or has evolved within the limits created by the orthodox model of medicine. This is a dogma of the religious type.

I am not suggesting that orthodox medicine is based on a single idea or that it is not open to new ideas or innovations. What I am suggesting is that any openness is limited by the boundaries of the model.

Orthodox medicine is nothing more than a model, it is not a monopoly on the truth (whatever that is). Plausibility and evidence are a function of the model, though the high priests of orthodoxy would have us believe otherwise.

Your last response seems to me to be of the ‘my medicine is better than your medicine’ type. No sane non-orthodox practitioner would suggest that their particular therapy could possibly replace orthodox medicine in its entirety – nor do I.

a) “the orthodox medical model of medicine” is nothing else than to “try out whether something does what you think it does”. Just plain old common sense, not restricted to medicine at all.

b) that the concept of a trial does not enforce the way some medicine or treatment is developed, but merely ensures that the claimed results are rigorously and independently tested. Everybody is free to dream up inventions as he sees fit – as long as the results stand up to scrutiny.